Treatment of acute bipolar depression: a review of the literature.

Abstract

OBJECTIVE:

Our goal was to ascertain the efficacy of various antidepressant treatments for acute bipolar depression.

METHOD:

English articles that reported on the efficacy of antidepressant treatments in bipolar depression were located by computerized Medline and manual search. These studies were systematically reviewed and response rates for each treatment were computed.

RESULTS:

The available data suggest that mood stabilizers, MAOIs, cyclic antidepressants, and ECT are all effective in treating bipolar depression. All antidepressant treatments with the exception of mood stabilizers have been reported to induce a manic/hypomanic switch.

CONCLUSIONS:

It is recommended that mood stabilizers may be the first step of treatment, followed by the addition of an antidepressant, especially a cyclic antidepressant. The specific symptoms profile of individual patients, such as anergic or psychotic features, may indicate more specific treatment options. ECT is an important measure for those who are pharmacotherapy-resistant or psychotic.